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Treatments and drugs
By Mayo Clinic staffNumerous treatments for depression are available. Standard depression treatment options include:
- Medications
- Psychotherapy
- Electroconvulsive therapy (ECT)
Emerging treatments for depression include:
- Brain stimulation
- Complementary and alternative treatments
In some cases, your primary care doctor can treat your depression. In other cases, you may benefit from treatment with a qualified mental health provider, such as a psychiatrist, psychologist or social worker.
Try to be an active participant in your depression treatment. Working together, you and your doctor or therapist can decide which treatment options may be best for your situation, depending on your symptoms and their severity, your personal preferences, insurance coverage, affordability, treatment side effects and other factors. In some cases, though, depression is so severe that a doctor, loved one or guardian may need to guide your care until you're well enough to participate in decision making.
Here's a closer look at your depression treatment options.
Medications
Dozens of medications are available to treat depression. Most people find the best relief of depression symptoms by combining medications and psychotherapy. Some medications for depression are antidepressants that have been specifically approved by the Food and Drug Administration (FDA) to treat depression. Doctors also can use their medical judgment to prescribe other medications that haven't been FDA approved to treat depression but that may be effective anyway — a common and perfectly legal practice called off-label use.
There are several different types of antidepressants. Antidepressants are generally categorized by how they affect the naturally occurring biochemicals in your brain to change your mood. To determine which antidepressant may be best for you, doctors typically follow general practice guidelines. They may also ask you to take a blood test called the cytochrome P450 test, which can help identify genetic factors that influence your response to certain antidepressants (as well as some other medications).
Other factors that are considered when choosing an antidepressant are your symptoms, your family history of depression, and other conditions you may have. Don't give up until you find an antidepressant or medication that's suitable for you — you have a good chance of finding one that works and that doesn't have intolerable side effects, even if it takes a few tries.
Most antidepressants are equally effective. But some pose a higher risk of serious side effects. Here's how antidepressants and other medications are generally considered when you're starting treatment for depression:
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Typical first choices. Many doctors start treatment with antidepressants by prescribing an antidepressant known as an SSRI — a selective serotonin reuptake inhibitor. This is because the side effects of the medications in the SSRI class of antidepressants are generally more tolerable than are those of other types of antidepressants, and they also generally work well. SSRIs include fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).
Other common first choices for antidepressants include serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine and dopamine reuptake inhibitors (NDRIs), combined reuptake inhibitors and receptor blockers, and tetracyclic antidepressants.
- Typical second choices. The class of antidepressants called tricyclic antidepressants (TCAs) has been around longer than has the SSRI class, and TCAs are still effective. But because TCAs tend to have more numerous and more severe side effects, they're often not prescribed until you've tried SSRIs first without an improvement in your depression.
- Typical last choices. The class of antidepressants called monoamine oxidase inhibitors (MAOIs) is often prescribed as a last resort, when other medications haven't worked. That's because MAOIs, while generally effective, can have serious harmful side effects. They also require strict dietary restrictions because of rare but potentially fatal interactions with certain foods. Newer versions of MAOIs that you stick on your skin as a skin patch rather than swallowing may have fewer side effects.
- Other medication strategies. Your doctor may also suggest other medications to treat your depression. These may include stimulants, mood-stabilizing medications, anti-anxiety medications or antipsychotic medications. In some cases, your doctor may recommend combining two or more antidepressants or other medications for better effect, which is sometimes called augmentation.
Side effects of antidepressants
All antidepressants can cause unwanted side effects. Not everyone experiences the same number or intensity of side effects, though. You may find that your side effects are so mild that you don't need to stop taking the antidepressant. Coping strategies also can help you manage side effects. In addition, side effects often go away or lessen within several weeks of starting an antidepressant.
If you experience unpleasant or intolerable side effects, don't just stop taking an antidepressant without consulting your doctor first. Some antidepressants can cause withdrawal-like symptoms unless you slowly taper off your dose.
Precautions when taking antidepressants
Although studies have shown that antidepressants are generally safe, some precautions are in order when taking them. The FDA now requires that all antidepressant medications carry black box warnings. These are the strictest warnings that the FDA can issue for prescription medications.
The antidepressant warnings note that in some cases, children, adolescents and young adults ages 18 to 24 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting an antidepressant or when the dose is changed. Because of this risk, people in these age groups must be closely monitored by loved ones, caregivers and health care providers while taking antidepressants.
Some antidepressants have the potential of causing serious or even life-threatening health problems, such as liver failure or a dangerous drop in white cell count. While such cases are rare, it's important to get blood work or other tests on schedule and stick to your treatment regimen. Make sure you understand the risks of the medications you're taking and that you're being properly monitored.
In addition, if you're pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn child or nursing child. Talk to your doctor about any concerns you have. Again, make sure you understand the risks of the various antidepressants. Working together, you and your doctor can explore options to get your depression symptoms under control.
Waiting for antidepressants to work
It can take as long as eight to 12 weeks to gain the full benefits of an antidepressant, although you may notice some improvements in your mood before that. Certain genetic factors may influence whether or not an antidepressant works for you and how long it takes for symptoms to improve. (DHF review) If you haven't had improvements in your mood and thoughts, your doctor may suggest either increasing your dose, combining medications or switching to a new medication.
Psychotherapy
Psychotherapy is another key depression treatment. It's often used along with medication treatment. Psychotherapy is a general term for a way of treating depression by talking about your condition and related issues with a mental health provider. Psychotherapy is also known as therapy, talk therapy, counseling or psychosocial therapy.
Through these talk sessions, you learn about the causes of depression so that you can better understand it. You also learn how to identify and make changes in unhealthy behavior or thoughts, explore relationships and experiences, find better ways to cope and solve problems, and set realistic goals for your life. Psychotherapy can help you regain a sense of happiness and control in your life and help alleviate depression symptoms, such as hopelessness and anger. It also may help you adjust to a crisis or other current difficulty.
There are several types of psychotherapy that are effective for depression. Cognitive behavioral therapy is one of the most commonly used talk therapies for depression. This type of therapy helps you identify pessimistic, negative beliefs and behaviors and replace them with healthy, positive ones. It's based on the idea that your own thoughts — not other people or situations — determine how you behave. Even if an unwanted situation doesn't change, you can change the way you think and behave in a positive way. Interpersonal therapy and psychodynamic psychotherapy are other types of therapy commonly used to treat depression.
Electroconvulsive therapy
In electroconvulsive therapy (ECT), electrical currents are passed through the brain to trigger a seizure. Although many people are leery of ECT and its side effects, it typically offers fast, effective relief of depression symptoms. Experts aren't sure how this therapy relieves the signs and symptoms of depression. The procedure may affect levels of neurotransmitters in your brain. The most common side effect is confusion, which can last from a few minutes to several hours. Some people also experience partial memory loss, but memory often returns.
ECT is usually used for people who don't get better with medications and for those at high risk of suicide. It may be the only treatment available for older adults with severe depression who can't take medications because of heart disease.
Hospitalization and residential treatment programs
It's not often that depression becomes so severe that you require psychiatric hospitalization. And even when depression is severe, it still may not be easy to decide if hospitalization is appropriate. If you can be treated just as effectively or better outside of the hospital, your doctor probably won't recommend hospitalization.
Psychiatric hospitalization is generally recommended only when you aren't able to care for yourself properly or when you're in immediate danger of harming yourself or someone else. Psychiatric hospitalization options include 24-hour inpatient care, partial or day hospitalization, or residential treatment, which offers a supportive place to live.
Nontraditional depression treatment options
If standard depression treatment hasn't been effective, you may want to try nontraditional depression treatments. These options, sometimes called neurotherapeutic treatments, involve direct stimulation of your brain. They include:
- Vagus nerve stimulation (VNS). VNS uses electrical impulses with a surgically implanted pulse generator to affect mood centers of the brain. The FDA approved this treatment in July 2005 for certain cases of severe or chronic, treatment-resistant depression.
- Transcranial magnetic stimulation (TMS). TMS is a procedure that uses magnetic fields to alter brain activity. A large electromagnetic coil is held against your scalp near your forehead to produce an electrical current in your brain.
- Deep brain stimulation. This is a highly experimental treatment for depression in which the brain is stimulated with surgically implanted electrodes.
